Wait time for Amelia Court appointments questioned

ASOs strive to see more clients more quickly but, Parkland patients continue to wait months

Nobles1

Raeline Nobles

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

Over the past year, the wait time to get an appointment at Parkland hospital’s Amelia Court appears to have gotten longer, although the staffing level appears to be about the same now as a year ago.

During that same time, community-based AIDS agencies in Dallas say they have expanded services and decreased wait times.

For new Parkland patients, the time from first contact to seeing a doctor can be as short as two weeks. But new patients trying to access services at the public clinic recently have reported waits of as long as four months.

Candace White, Parkland media spokeswoman, said that the clinic is taking new patient appointments as early as February and through March 1. She said she confirmed that with Sylvia Moreno, the hospital’s director of HIV services.

White attributed the delay to an increase in the number of patients accessing the clinic’s services due to successful HIV testing efforts throughout Dallas County. Some of the longer wait times quoted over the past few weeks may have been due to the holiday, she said.

However, when a Dallas Voice staff member called Amelia Court on Tuesday, Jan. 10, to make an appointment, he was transferred to voicemail to leave a message. As of deadline time on Thursday, Jan. 12, more than two days later, no one from the clinic had returned the call.

Another caller to Amelia Court was told that those February and March appointments White cited are reserved for established patients only. The next available appointment for first intake for new clients who want access to Amelia Court is April 23, the caller was told.

The Ryan White CARE Act, which funds many of the treatment programs for persons with HIV, specifies patients must receive “access to care within three weeks of presenting,” Dr. Gary Sinclair, former medical director of Amelia Court, said.

While he was at Amelia Court, Sinclair said that he and his staff reduced the waiting time to access medical care to two weeks. He left UT Southwestern and Parkland two years ago and is now an independent consultant involved in covering for physicians for Ryan White programs.

For years, all Parkland primary AIDS care was done at Amelia Court, located on Harry Hines Boulevard, a block from the main hospital. However, to relieve overcrowding at Amelia Court, doctors with experience in treating people with the virus have been seeing patients at three of the hospital’s Community Oriented Primary Care facilities in Dallas.

Parkland began opening the COPCs in 1987 to relieve its main emergency room of treating non-emergency cases.

The clinics were designed to provide convenient and affordable healthcare throughout Dallas County.

Parkland

HIGH RISE CLINIC | Amelia Court’s HIV services will move to the new Parkland Hospital under construction across Harry Hines Boulevard from the old facility. (DavidTaffet/Dallas Voice)

Some of the facilities also have specialties. Two clinics — Bluitt-Flowers Health Center in South Dallas and Southeast Dallas Health Center in Pleasant Grove — were designated as HIV treatment sites.

A third — deHaro-Saldivar Health Center in Oak Cliff — previously treated adolescents and young adults with HIV, but that service has been discontinued.

Parkland’s clinic has been staffed at about the same level for the past several years.

But as HIV has changed to a manageable chronic illness, Sinclair said that there has been “a normalization of care.”

That normalization may include longer waiting times for appointments at the public hospital, something that is common in other specializations.

But while Parkland strives to keep the wait time for primary care down, some local agencies that provide clinical service to people with HIV at low or no cost say they have expanded their service and will see new patients quickly.

“On a very human level, it can be quite terrifying to want and need medical care and not be able to find it,” AIDS Arms Executive Director Raeline Nobles said. “AIDS Arms built its second HIV clinic to help with these exact problems in significant and positive ways.”

The agency opened Trinity Health & Wellness Clinic in Oak Cliff this past fall and continues operating Peabody Health Center in South Dallas. Both offer full primary care for people with HIV.

AIDS Arms accepts Medicare and Medicaid as well as private health insurance. And like the county hospital, medical care is free for low-income people without any coverage and is provided on a sliding-scale for others.

Intake takes about a week to complete, Nobles said. Once a person who has an HIV-positive diagnosis is registered as a client, doctors at Trinity Clinic can see a new patient that week.

“With fast access to medical appointments at our Trinity and Peabody clinics and five licensed providers, we are a partner in the solution to very large and disturbing access to care problems in our community,” Nobles said.

The agency is seeking to expand the services it offers its patients and is currently looking for specialists in ophthalmology, cardiology and renal care to supplement its care.

In addition, AIDS Arms is involved in drug research trials, something Amelia Court no longer does.

Sinclair said he believed that was part of a shift in federal research dollars away from “’How do we treat people?’ to ‘How do we eliminate the epidemic?’”

In addition, AIDS Arms is offering several new services to its patients at its Trinity clinic.

Legal Hospice of Texas will soon begin providing on-site legal assistance for disability, social security and HIV-related discrimination issues. Bryan’s House will be providing free childcare for patients visiting the clinic on Thursday and Fridays beginning next week. And once a week, onsite psychotherapy services will be offered.

Resource Center Dallas offers a variety of specialized medical services at its Nelson-Tebedo Community Clinic on Cedar Springs Road. Dental care is the most frequently accessed and something not provided by other agencies or Parkland.

With a recent expansion of facilities at the clinic, RCD Communications and Advocacy Manager Rafael McDonnell said the wait time for an appointment is three weeks or less. He said the clinic is able to treat emergencies even more quickly.

This article appeared in the Dallas Voice print edition January 13, 2012.

—  Kevin Thomas

Big changes ahead for ASOs

AIDS agencies have to look for ways to branch out if they want to survive and thrive under health care reform

Tammye Nash  |  Senior Editor
nash@dallasvoice.com

An estimated 1.2 million people in the United States are living with HIV infection, and 20 percent of them are not even aware of it, according to the Centers for Disease Control. And a CDC report released in early August suggests that there are about 50,000 new HIV infections each year.

And yet, federal funding for HIV/AIDS services have remained flat for the last five years — from funding for medical services to research dollars to money for support services — according to Raeline Nobles, executive director of AIDS Arms Inc.

And that means, Nobles and Resource Center Dallas Executive Director and CEO Cece Cox agreed this week, that the nonprofit, community-based organizations that have been the backbone have to look ahead and keep their options open to remain viable.

Changes in the way that federal funds through the Ryan White CARE Act are distributed — requiring that 75 cents of every Ryan White dollar be used for core medical services — give an edge to nonprofits that operate clinics. And that means that AIDS Arms, which just opened its second clinic last month — is “more competitive at the national, state and local levels,” Nobles said. “With the number of people who are uninsured and living at poverty levels, access to any kind of medical care is a priority. So if you are providing those kinds of services, it does give you an edge.”

Agencies that don’t provide those kinds of services, she added, can get in on that competitive edge by collaborating with those that do.

“There’s really no new money to sustain new agencies,” Nobles said. “AIDS is definitely off the docket in terms of diseases people seem to be concerned about. In fact, any HIV provider across the country who is not considering all their options is in a great deal of denial, and that may well come back to bite them rather severely.”

There’s also health care reform to consider, with several parts of the law passed in late 2010 still to be implemented. That reform, said Cox, is changing the face of community health clinics, like RCD’s Nelson-Tebedo Clinic, and HIV/AIDS service programs.

“Our nutrition program is a good example,” Cox said. “It has really been hammered in terms of federal funds, so we have focused on supporting the program through the community, foundations and corporations. … It is an amazing puzzle we have pieced together, even with cuts in traditional funding streams. But we have managed. We have done the things we felt we had to do.”

And there are more changes coming. Nobles said that if the Ryan White funds survive beyond 2013 when more health care reform measures go into effect, “it likely won’t include any money for outpatient services like we offer” at the Peabody Clinic and the new Trinity Clinic.

“So we have to take a look at what we do best, and we can use our model and globalize it into different areas. We have to become even more sustainable. Diversification of business is key to survival,” Nobles said. “It can’t just be about HIV and AIDS any more.”

Nobles said “serious discussion has been going on at AIDS Arms for at least two years, at the board and staff levels” about how the agency can expand its focus beyond HIV/AIDS and remain viable.

“We have to diversify our business plan. The situation has been serious for awhile and it is becoming even more serious for our board,” Nobles said. “We hope to have, by early 2012, a final business plan in place to move into the future.

“Health care reform is a great thing for a lot of people, but it poses real challenges for the nonprofit sector. You have to stay ahead of the curve, or health care reform will run right over you. We definitely want to stay ahead of that curve,” she continued. “The HIV nonprofit community has the best model of care and support the U.S. has ever seen. That model can be globalized to include care for other disease — heart disease, cancer, diabetes.”

Cox said that staff and board members at Resource Center Dallas also began planning for the changing future some time ago, and its current capital campaign to build a new facility is part of the plan.

“Nobody seems to have all the answers right now. The feds won’t say what they will and what they won’t fund. So savvy business people are already thinking, ‘If this funding goes away, what can we do instead?’” Cox said.

“Everybody feels like the challenge working in the nonprofit sector is that you are always aware there is so much more that needs to be done,” she added. “But doing more requires more space, more staff, more resources. And to have that, you have to build the business in a way that is sustainable. And you have to remember, nobody can do everything.”

Both Cox and Nobles are quick to remind that even though their agencies are “nonprofits,” they are businesses nonetheless, and have to be operated with an eye toward success.

“There has been, and probably still is, the mindset about nonprofits. People expect the nonprofits to be there to provide all these services without caring about costs,” Cox said. “But the fact is, nonprofit or not, these agencies have to be run like a business. You have to anticipate, plan ahead. You have to put the structures in place and you have to invest. We make large investments in our staff and in technology. For-profit business sell stock and they answer to their stockholders. We get our money from our donors, and we have an obligation to let our donors know what we do with their money and to let them know we use it responsibly.”

This article appeared in the Dallas Voice print edition November 11, 2011.

—  Kevin Thomas

With AIDS funding at risk, Boehner triples budget to defend DOMA

Today I got an “action alert” email from AIDS United and AIDS Interfaith Network, urging me to call my senators and representatives today and urge them to vote against any legislation that would create drastic cuts in federal funds for “essential programs” for people with HIV/AIDS.

House Speaker John Boehner

The email noted that a special congressional committee is working right now on a plan to reduce the deficit, and that cuts to programs like Medicaid, Medicare, Ryan White CARE Act, food stamp programs and unemployment benefits could be on the chopping block. “Cutting these programs will make things worse, not better. People will be hurt and access to life-saving HIV care will be lost,” the email said.

I found the email in the inbox about the same time I found an email from the National Minority AIDS Council pointing out that less than a week after the House Appropriations Committee proposed slashing funding for the Centers for Disease Control and Prevention‘s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention by $32.7 million, and cutting the Prevention and Public Health Fund by an amazing $1 billion, Republican Speaker of the House John Boehner has tripled the House’s budget for defending the Defense of Marriage Act, legislation that prevents the federal government from recognizing same-sex marriages, even though performed in jurisdictions that do legally recognize them.

Back in March, Boehner decided that the House of Representatives, under Republican control, would hire a law firm to defend DOMA in court, originally budgeting President Obama had announced in February that he was instructing the Justice Department to no longer defend the law in court, because at least part of DOMA — the part which denies legal federal recognition and benefits to same-sex couples who have been married in jurisdictions with gay marriage is legally recognized — is unconstitutional under the Full Faith and Credit Clause of the U.S. Constitution.

That decision came after federal district judges had declared DOMA unconstitutional in two separate lawsuits.

It’s bad enough that Boehner and the Republicans in the House feel the need to spend up to $750,000, as per the initial agreement, to hire someone to defend such an unjust law in the first place. Doing so while at the same time threatening to force the country to default on its debts instead raising the debt ceiling was unconscionable. And now, as thebudget crunch continues and Tea Party Republicans continue to complain about the country’s debt and refuse to consider revenue increases, Boehner and his merry band have decided to up the limit they will pay Kircher to defend DOMA to $1.5 million.

Daniel C. Montoya, deputy executive director of the National Minority AIDS Council, said: “I urge Speaker Boehner to reconsider his decision. 56,000 Americans are infected with HIV each year. More than half of those were among gay and bisexual men. Spending taxpayer money to delegitimize relationships that have been shown to promote healthier lifestyles is antithetical to American values, contrary to the conservative belief in limited government and detrimental to public health. In this time of fiscal and economic strife, certainly the Speaker and his colleagues can find better ways to spend this money.”

Montoya also suggested that Boehner’s decision raises “serious questions about his purported commitment to fiscal responsibility.” Yeah, ya think? If you agree and want to express your opinion to your representatives in Congress, you can call, toll free, 1-888-907- 1485.

—  admin

HUD grants to help with housing for those with AIDS

President Barack Obama

HOPWA program will administer $9.1 million in competitive grants to develop, improve housing options

DANA RUDOLPH  |  Keen News Service
lisakeen@mac.com

The U.S. Department of Housing and Urban Development on Monday, May 23 announced up to $9.1 million in grants to address the housing needs of people with low-incomes living with HIV/AIDS.

The competitive grants, offered through the Housing Opportunities for Persons with AIDS Program, are intended for states and local communities to create more integrated strategies and partnerships between housing programs and other health and human services.

David Vos, director of HUD’s Office of HIV/AIDS Housing, said in a statement on the HUD website that the partnerships will help show “how to take holistic approaches to serving some of the nation’s most vulnerable, persons living with chronic health challenges and risks of homelessness.”

At the end of the three-year grants, HUD will evaluate and publish the results of grantees’ efforts in an Integrated HIV/AIDS Housing Plan. The IHHP will be an online resource to help communities “integrate the delivery of housing along with medical and other supportive services,” said Vos.

The grants and IHHP are intended to support both President Obama’s National HIV/AIDS Strategy and his Federal Strategic Plan to Prevent and End Homelessness.

President Obama released a National HIV/AIDS Strategy in July 2010 with specific, measurable targets to be achieved by 2015. One of the strategy’s goals is to help people living with HIV “who have challenges meeting their basic needs, such as housing.”

The strategy says that “non-medical supportive services, such as housing, food, and transportation, are “critical elements of an effective HIV care system.”

The strategy calls for increasing from 434,000 to 455,800 the number of people receiving HIV-related services under the Ryan White Care Act who have permanent housing. The Ryan White Program, the largest federally funded program for people with AIDS, provides services for those who do not have sufficient health care coverage or financial resources.

According to the strategy, “Individuals living with HIV who lack stable housing are more likely to delay HIV care, have poorer access to regular care, are less likely to receive optimal antiretroviral therapy, and are less likely to adhere to therapy.”

One 12-year study of people living with HIV in New York City, cited in the strategy, found that “housing assistance had a direct impact on improved medical care, regardless of demographics, drug use, health and mental health status, or receipt of other services.”

But HUD’s announcement comes only weeks after the U.S. House passed a budget for Fiscal Year 2012 that AIDS activists believe will diminish HIV programs and services.

The proposed budget, authored chiefly by Rep. Paul Ryan, a Wisconsin Republican, calls for dramatic cuts in Medicaid, which provides health insurance coverage for people with low incomes.

And it calls for dramatic cuts in Medicare, which provides health insurance coverage for Americans 65 and older and for people with disabilities, including AIDS.

In a letter to members of the House in April, a large coalition of groups serving people with HIV had urged a “no” vote on the plan, saying it “will do irreparable harm to people living with HIV disease as well as those at risk for HIV infection.”

In addition to addressing the housing needs of people living with AIDS, HUD has also taken several significant steps towards addressing housing discrimination in the LGBT community.

It has issued proposed new regulations intended to ban discrimination on the basis of sexual orientation or gender identity in its core housing programs.

It also clarified that, although the Fair Housing Act — a pivotal civil rights act that prohibits discrimination based on race, color, religion, national origin, sex, disability and familial status, does not specifically cover sexual orientation- or gender identity-based discrimination, it may still provide them with protection in other ways.

For example, discrimination against a gay man because of fear he will spread HIV/AIDS may constitute illegal discrimination on the basis of a perceived disability, HIV/AIDS.
HUD has also instructed staff to inform individuals about state and local LGBT protections that may apply to them. And HUD has told all its grant applicants they must comply with such laws, where they exist.

Applications for the new grants should be submitted at grants.gov by Aug. 2. Winners are expected to be announced by Sept. 20.

© 2011 by Keen News Service. All rights reserved.

—  John Wright

Legal Hospice of Texas receives ‘cy pres’ award

LEGAL AID | Legal Hospice of Texas received a “cy pres” award that will help them deliver services to low-income persons are HIV-positive or have other life-threatening illnesses in 16 North Texas counties. (David Taffet/Dallas Voice)

Legal Hospice of Texas has received an award of $94,969 as part of the largest “cy pres” award to legal aid in Texas.

“Cy pres” awards are residual funds from a class action suit or other legal proceedings that cannot be distributed to class members or the intended beneficiaries for a variety of reasons. The class action suit, Meyers et. al v. State of Texas, et. al, involved allegations that the state violated Title II of the Americans with Disabilities Act by charging Texans with disabilities for the standardized blue placards used for parking.

Executive Director Roger Wedell said attorneys involved in class action suits, along with mediators and judges, can influence how these excess funds are disbursed. Funds that are not distributed would be paid to the state.

Since the state was the defendant, Wedell said there was an interest in not returning this money to the state. The “cy pres” funds received from this suit will help provide legal aid to Texans with disabilities.

More than $2.6 million from the Meyers lawsuit was awarded to six legal aid organizations that provide civil legal services to low income Texans with disabilities. An additional $6.4 million from the suit will flow to other non-profit organizations that serve the needs of Texans with disabilities.

The funds come at a critical time for the agency, Wedell said, which has been particularly hard-hit by the recession.

Legal Hospice of Texas began as a volunteer organization that assisted with end-of-life paperwork at evening and weekend clinics at the Dallas Gay Alliance office on Cedar Springs Road. The organizations received its first grants in 1989 from the Dallas and Texas Bar foundations, adding its first staff when Ryan White CARE Act funding began in 1990.

In addition to Wedell, the organization now has two paid staff attorneys and works with about 40 volunteers from individual to large law firms.

Legal Hospice of Texas provides services to low-income persons are HIV-positive or have other life-threatening illnesses in 16 North Texas counties. Those with HIV must already be registered through one of the other agencies that can refer persons for service.

Wedell said most of Legal Hospice’s work is in three areas: estate planning, wills and preparation of other end-of-life documents. Attorneys also assist clients with legal issues relating to Social Security, unemployment insurance and other public benefits. Employment consultations with people newly diagnosed is a third area of expertise for Legal Hospice.

—  David Taffet

AIDS Outreach gets SMART

Fort Worth agency offers alternative to ‘12-step’ addiction programs that’s tailored to gay men with HIV

Tammye Nash | Senior Editor nash@dallasvoice.com

FORT WORTH — Addiction recovery programs aren’t one size fits all.

That’s why AIDS Outreach Center recently started a new program, SMART, according to Shawna Stewart, the agency’s director of mental health services, and Leslie Guditis, the therapist heading up the new program to help the agency’s HIV-positive clients overcome addictions to alcohol and drugs.

Self Management and Recovery Training — or SMART — is intended as an alternative to “12-step” programs, Stewart said. But they stressed they aren’t suggesting SMART is “better than” 12-Step programs. “It’s just different,” Stewart said. “It’s another option for people who haven’t had success with other programs.”

Although AIDS Outreach recently had to close its Arlington offices and cut staff due to budget constraints, SMART will continue. Stewart said it’s funded with a special grant through the federal Ryan White CARE Act. The grant pays for Guditis’ part-time position to administer the program.

SMART, Guditis said, is different because “it doesn’t come from a disease model. It doesn’t label. You don’t go to a meeting and stand up and say, ‘I am an alcoholic.’”

Instead, the SMART program “teaches more about taking responsibility and looking at why one drinks or uses drugs or has any addiction, like an addiction to sex, eating. And when you know the ‘why,’ you can manage that ‘why’ instead of just saying, ‘I will never do it again.’”

“This program is about teaching an individual the tools that hopefully last a lifetime, rather than saying go to a meeting every day or every week,” Guditis said.

The 12-step programs “come from a disease model,” the therapist said. “I am not bashing any other programs. But I do think that this is a more positive way to look at addiction.”

Stewart believes this different model for recovery could be more effective for some of AIDS Outreach’s clients, many of whom are gay, because it doesn’t include reliance on a higher power. Many gays and lesbians and many people with HIV, she said, have had bad experiences with religion. So the idea of relying on a “higher power” may be less effective for people who may have felt rejected by God, she suggested.

Although she said she doesn’t necessarily believe SMART would work better for LGBT people or those with HIV in general, Guditis does think it would work better for some of them.

“I think LGBT and people with HIV sometimes already have a lot of shame, and this [SMART] is all very positive,” Guditis said. “It helps people feel like they have control over their lives. What we are trying to do is empower people.

“People with HIV feel powerless in a lot of ways, and this is really a self-esteem-building program,” she continued. “I went to a [SMART] meeting [not specific to people with HIV or LGBT people], and the people in the meeting were so proud of their ability to be in control of the choices they make. They were proud to feel like they do have a choice. I saw people’s chests almost swell with pride in being able to manage their behavior.”

Guditis also noted that despite the acronym, a person doesn’t need to be “smart” to succeed in the program. “The techniques are very simple and pretty well spelled out,” Guditis said. “This is a kind of psycho-education type program. People don’t just talk about their problems or a binge over the weekend. It’s a more positive and supportive, a mutual learning environment. There are no sponsors, no hierarchy. It’s a setting of equals with a facilitator managing the discussion. That is my job, to be the facilitator.”

Another difference from a 12-step program is that SMART doesn’t require abstinence, Stewart and Guditis said.

“Abstinence is promoted, but if someone comes to a meeting and they have been using, they are still welcome in,” Guditis said. “We work from that place to manage the behavior, and not try to make them feel shamed for using. We talk about emotions, triggers for addictive behavior. People take pride in being in control of their behaviors.”

Guditis, who recently received a doctorate in family therapy from Texas Women’s University, spent the month of June training in the SMART program. She held the first SMART session at AIDS Outreach on July 6. “We initially wanted to have three SMART groups each week, but we are starting with one, each Tuesday. We want to have at least two groups a week, though,” Guditis said. “We will add more as we see the need.”

The sessions at AIDS Outreach, she added, are only for the agency’s clients. If the program proves effective at AIDS Outreach for alcohol and drugs, it could eventually be expanded to include those fighting other addictive behaviors, too.

This article appeared in the Dallas Voice print edition July 9, 2010.

—  Michael Stephens